Illegal immigrants may be majority at Harris hospitals
By Todd Ackerman
The Houston Chronicle, March 23, 2010
Illegal immigrants likely would become the largest patient pool of the Harris County Hospital District as a result of health care reform unless the taxpayer-funded institution can attract more insured patients than it currently serves, according to public health experts.
Hospital district President David Lopez said he's optimistic the district can better market itself to capture a larger percentage of covered patients but acknowledged that even if the district is successful, it must prepare for major shifts that will come with the landmark legislation President Barack Obama signed into law Tuesday.
'With more people qualifying for coverage beginning in 2014, some of whom will go to other hospitals for their care, there will be questions about how to best maintain our payer mix,' Lopez said. 'Certainly, the undocumented will become a bigger proportion of our patients who don't have insurance.'
Illegal immigrants currently account for 18 percent of the district's patients.
Lopez said the district must capture a large enough percentage of paying patients to remain viable but added that he's confident staff will figure out a way to make the finances work. He said he doesn't yet know how large the percentage needs to be.
Lopez also said he hopes that between now and 2014, Congress achieves some sort of immigration reform that reduces the district's burden of caring for illegal immigrants. He speculated that such reform might allow illegal immigrants to buy into an insurance program.
The district, which was created by voter referendum in 1965 and came into existence as a taxing authority in 1966, provides safety-net care to low-income, uninsured and underinsured and vulnerable populations. Harris County has the nation's highest rate of uninsured patients.
Health care reform is ultimately expected to extend coverage in the county to an additional 750,000 to 800,000 people, or between 90 percent and 95 percent of its uninsured U.S. residents.
'The challenge for the hospital district will be to become competitive for those new patients, patients who beginning in 2014 will have coverage and suddenly can go to Methodist or Memorial Hermann or St. Luke's,' said Dr. Brent King, chairman of emergency medicine at the University of Texas Health Science Center at Houston and a practicing doctor at both Memorial Hermann Hospital and the district's Lyndon B. Johnson Hospital. 'Will they stay at the district or instead go to hospitals perceived as more customer-friendly?'
Excess of hospital beds
Currently, the district captures 18 percent of Harris County patients eligible for Medicaid, 3 percent of those eligible for Medicare and 0.5 percent of those with private insurance, according to the Teaching Hospitals of Texas, a nonprofit group focused on state, public and nonprofit hospitals and health systems.
King said the newly covered patients will be attractive to Houston-area private hospitals that will be under pressure to fill or eliminate beds expected to be 30 percent underutilized within a couple years, when Methodist and Texas Children's have finished construction of hospitals between the Beltway and Katy.
Lopez said private hospitals won't be able to accommodate all the new patients and will be grateful for the district.
But he also said the district needs to do a better job of 'changing people's perceptions of who we are, that our quality, outcomes, cost and patient satisfaction surveys compare very favorably with other hospitals.'
Lopez also noted that the district is making improvements to its facilities, such as converting maternity rooms from four-bed units to two.
John Guest, former president of the hospital district and current president of the Teaching Hospitals of Texas, said he thinks a shifting of patients will alleviate much if not all of the crowding that plagues the district. He said he does not know that the shift will leave the district with mostly illegal immigrants, noting that the homeless, the mentally ill and other patients unable to navigate the health care system need a safety net.
'I think the community recognizes the importance of the hospital district,' Lopez said. 'There will always be a need for a publicly funded system that addresses the needs of individuals who don't have health care coverage.'